|Year : 2021 | Volume
| Issue : 1 | Page : 66-67
Skeletal fluorosis: Problem that runs deep
Chaitanya Yerawar1, Aditi Kabde1, Santosh Durugkar2, Prerana Deokar3
1 Department of Endocrinology, Shree Narayana Institute of Medical Superspeciality, Nanded, Maharashtra, India
2 Department of Nephrology, Abhyuday Lifecare Superspecialitry Hospital, Nanded, Maharashtra, India
3 Department of Biochemistry, Shree Narayana Institute of Medical Superspeciality, Nanded, Maharashtra, India
|Date of Submission||13-Jan-2021|
|Date of Decision||15-Feb-2021|
|Date of Acceptance||20-Feb-2021|
|Date of Web Publication||02-Mar-2021|
Department of Endocrinology, Shree Narayana Institute of Medical Superspeciality, Nanded, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Yerawar C, Kabde A, Durugkar S, Deokar P. Skeletal fluorosis: Problem that runs deep. Apollo Med 2021;18:66-7
Skeletal fluorosis is a worldwide health problem. In India, fluorosis is endemic in many states, the most common etiology being consumption of fluoride-rich water derived from deep bore wells., A 38-year-old male presented to the endocrinology outpatient department with multiple joint pain and restricted movement at elbow joint for the past 8 years. On physical examination, he had noticeable brown-discolored and mottled enamel [Figure 1]a. X-ray of the forearm was suggestive of interosseous membrane calcification and periosteal new bone formations [Figure 1]b. Ossification of the interosseous membrane and brown-discolored mottled enamel clinched the diagnosis of fluorosis. On further enquiry, the patient revealed similar brown discoloration of teeth in other family members. X-ray of the pelvic region, cervical spine, knee joint, and ankle joint revealed typical features of skeletal fluorosis [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f. His biochemical evaluation was as follows: serum calcium 8.74 mg% (8.8–10.2 mg%), phosphorus 2.5 mg% (2.5–4.5 mg%), alkaline phosphatase 1049 U/L (80–306 U/L), 25(OH) vitamin D 42 ng/ml (30–100 ng/mL), creatinine 1.4 mg/dL (0.6–1.4 mg/dL), serum fluoride 155.7 mg/L (0.02–0.05 mg/L), urine fluoride 45.4 (0.2–1.1 mg/L), and water fluoride 5.77 mg/L (up 0.02–0.05 to 1.0 mg/L) (ion liquid chromatographic method). Other routine biochemical investigations were within normal limits. Estimation of fluoride in drinking water and skeletal radiographs alone are enough to confirm the diagnosis of fluorosis. Hence, based on his clinical, biochemical, and radiological features, diagnosis of fluorosis was confirmed. The patient was advised to avoid fluoridated water, and he was treated with calcium, ascorbic acid, and Vitamin D supplementation. This case highlights the long and painful journey many patients endure due to delay in diagnosis, resulting from a condition which is preventable if detected early. Regular dental examination in the endemic area can be crucial for early diagnosis before skeletal changes sets in the patient, family, and the community.
|Figure 1: (a) Dental fluorosis. Brown discolored and mottled enamel. (b) Radiograph of the forearm showing interosseous membrane calcification and periosteal new bone formations. (c) Radiograph of the pelvis showing increased bone density along with calcification of posterior sacroiliac ligament (arrows). (d) Lateral radiograph of the cervical spine showing diffuse bone condensation with calcification of the posterior longitudinal ligaments (arrows). (e) Radiograph of the knee joint showing bony exostosis over femur, tibia and fibula (arrows). (f) Radiography of the ankle joint revealed multiple exostoses (arrows)|
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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